A healthy 18-year-old girl presented to a local emergency room with 48 h of
abdominal pain and
vomiting. A radiological and biochemical diagnosis of moderate
acute pancreatitis was made. Bloodwork demonstrated prominent hypertriglyceridaemia (HTG) of 19.5 mmol/L (severe HTG: 11.2-22.4), detectable urine
ketones and a random
blood glucose of 13 mmol/L dropping to 10.5 mmol/L on repeat (normal random <11).
Ketone levels were deemed consistent with fasting
ketosis after 48 h of
vomiting. There was no known history of diabetes in the patient. Management included aggressive
rehydration and
pain control, yet the patient rapidly decompensated into
shock requiring intensive care unit support. Blood
gases revealed severe
metabolic acidosis (pH 6.99) and unsuspected underlying
diabetic ketoacidosis was diagnosed. The HTG gradually resolved following intravenous fluids and
insulin infusion with slower correction of the
metabolic acidosis. Importantly, her glycated haemoglobin was 12%, indicating the silent presence of chronic
glucose elevations.